Abstract
The COVID-19 pandemic required significant public health interventions from local governments. Although nonpharmaceutical interventions often were implemented as decision rules, few studies evaluated the robustness of those reopening plans under a wide range of uncertainties. This paper uses the Robust Decision Making approach to stress-test 78 alternative reopening strategies, using California as an example. This study uniquely considers a wide range of uncertainties and demonstrates that seemingly sensible reopening plans can lead to both unnecessary COVID-19 deaths and days of interventions. We find that plans using fixed COVID-19 case thresholds might be less effective than strategies with time-varying reopening thresholds. While we use California as an example, our results are particularly relevant for jurisdictions where vaccination roll-out has been slower. The approach used in this paper could also prove useful for other public health policy problems in which policymakers need to make robust decisions in the face of deep uncertainty.
Highlights
The COVID-19 pandemic has wreaked havoc across the US, causing over 37 million confirmed cases and 600,000 deaths, and state-wide shutdowns of all non-essential businesses
Data Availability Statement: The code and data underlying the results presented in the study are available from https://github.com/ RANDCorporation/covid-19-reopening-california
Reopening plans [1,2,3,4] have been proposed as phased strategies, in which the state allows economic activity to resume based on meeting COVID-19 incidence targets
Summary
The COVID-19 pandemic has wreaked havoc across the US, causing over 37 million confirmed cases and 600,000 deaths, and state-wide shutdowns of all non-essential businesses. As state officials navigate the pandemic, they must manage both health and economic goals. Reopening plans [1,2,3,4] have been proposed as phased strategies, in which the state allows economic activity to resume based on meeting COVID-19 incidence targets. Pandemics often follow oscillatory waves of infection, and many states have already been forced to revise their plans, either shutting down after new outbreaks or adjusting which activities are allowed in each phase. To ensure long-term success in combating the pandemic, local policymakers need to consider the trade-offs underlying reopening decisions, while accounting for deep uncertainties. Since one-time lockdowns have proven to be insufficient to control the pandemic, a coherent, long-term strategy is needed. Instead of adopting a stable, pre-defined strategy, local policymakers have changed regulations and instated NPIs adaptively, often adopting NPIs based on the decisions of other jurisdictions [5] without necessarily supporting every deliberation
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